Linezolid use for drug-resistant tuberculosis in Georgia: a retrospective cohort study

• Type of Material: Article
• Authors: L Mikiashvilli, National Center for Tuberculosis and Lung Diseases; M Kipiani, National Center for Tuberculosis and Lung Diseases; Marcos Schechter, Emory University; Z Avaliani, National Center for Tuberculosis and Lung Diseases; N Kiria, National Center for Tuberculosis and Lung Diseases; Russell Kempker, Emory University
• Language: English
• Date: 2020-04-01
• Publisher: INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Ingenta
• Final Published Version (URL): http://dx.doi.org/10.5588/ijtld.19.0444
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE
• Volume: 24
• Issue: 4
• Start Page: 436
• End Page: 443
• Grant/Funding Information: The study was funded in part by the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (K23AI103044 and R21AI122001 to RRK), the NIH Fogarty International Center (D43TW007124), the Georgia Clinical and Translational Science Institute (UL1TR000454) and the Emory Global Health Institute
• Keywords: Science & Technology; PYRIDOXINE; tolerability; oxazolidinones; MYCOBACTERIUM-TUBERCULOSIS; TB; Respiratory System; EFFICACY; efficacy; Life Sciences & Biomedicine; quinolone resistance; IMPACT; safety; OUTCOMES; TOLERABILITY; Infectious Diseases; SAFETY; MULTIDRUG-RESISTANT

Abstract

SETTING: Data on the long-term use of linezolid (LZD) in the treatment of drug-resistant pulmonary tuberculosis (DR-PTB) are limited. OBJECTIVE: To assess safety, tolerability and efficacy of LZD-containing regimens for the treatment of DR-PTB in the country of Georgia. DESIGN: A retrospective study was conducted among DR-PTB patients receiving LZD 600 mg/day as part of newly implemented regimens (bedaquiline or delamanid, repurposed and second-line drugs) from July 2014 to October 2015 in programmatic conditions and following WHO recommendations. RESULTS: One hundred mostly male (82%) patients with a median age of 33 years received LZD. Most patients (77%) had previously been treated for TB; 57% had extensively drug-resistant TB. The median duration of LZD use was 503 days (interquartile range 355–616). LZD-associated adverse events occurred in 12 patients, leading to discontinuation in 4 (2 each due to peripheral neuropathy and cytopenias), and dose reduction to 300 mg/day in 6 cases (4 due to peripheral neuropathy and 2 for cytopenias). Almost all patients (95%) achieved culture conversion and 79% had a successful treatment outcomes. CONCLUSION: Treatment regimens including lengthy LZD use showed fairly good safety and tolerability and were associated with high rates of culture conversion and favorable outcomes.